Appliance Repair Request Form

Appliance Repair Request Form
Preferred Appointment date.
Are you the Authorised Bill Payer -

YES - GO TO 2.NO - COMPLETE SECTION 1. - i.e Letting Agent, Landlord, Housing Association.

2. CONTACT NAMES FOR ACCESS AND WORKS ADDRESS.
Name of person(s) providing access & Full Address of property to visit.

We will send you a payment Link once we have confirmed your job number, date of attendance & the name of the engineer attending.
1st Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
1st Name Email*
example@example.com
2nd Contact Name

First NameLast Name
2nd Name Phone Number
Please enter a valid phone number.
2nd Name Email
example@example.com
Address of Property to be attended to carry out the work(s)*

Street Address

Street Address Line 2

CityCounty or London Sub area i.e Camden, Hampstead

Postal Code
Parking Details - If the engineer cannot legally park his vehicle, we will contact you. *

3. APPLIANCE DETAIL(S) & PAYMENT INFO.
Appliance Information

Please have your appliance details handy to complete this section.
Photos required - Upload photos of the equipment that needs repair. The Make/Model/serial number(s) is usually found by opening the door and looking for a sticker around the door area. For Fridge Freezers by the left hand side of the salad drawer area. excludes hobs.*

1. rating plate if possible. 2. Full view of appliance. 3. All doors open. 4. As you choose.
Cancelof

List of Equipment - i.e freestanding or built in, range cooker, american style fridge freezer etc*

	type of appliance	Make & Model no.	serial number	Problem Description & approx age.
1
2
3
4
5

Are the appliance(s) listed above fully accessible? i.e double ovens, stacked? Placed in a cupboard space, that needs door/frames removing?*

YesNo
TRIAGE - Is anything broken (door handles feel loose), something not heating, or any error codes showing? So, we can check if a part is needed beforehand (triage) - type any additional in 'special instructions'.*

YesNo
FOR ALL REFRIGERATION PRODUCTS WE NEED THE APPLIANCE TO BE TOTALY ICE FREE, SO THAT OUR ENGINEER CAN ACCESS ANY REAR PANELS - IF IT IS ICED UP PLEASE DEFROST IT FULL BY SWITCHING OFF. OUR STAFF CAN ADVISE YOU FURTHER.
please confirm if

ice freeiced up
any notes enter here -: remember - The more info regarding the fault issues you can provide the better. Do you have any special instructions? i.e Key safe code, gate code, restricted access, any disability for priority service etc..
Parking restrictions etc.
Signature / Terms & Conditions
Please verify that you are human*
Should be Empty:

Name of person(s) providing access & Full Address of property to visit.